The RET protein encoded by RET proto-oncogene is a receptor tyrosine kinase that serves as a potential therapeutic target in non-small cell lung cancer (NSCLC) . In NSCLC, the incidence of RET fusions variants ranges from 1%-2% and is more common in younger, non-smoking patients. Traditional chemotherapy, immunotherapy, and multitarget kinase inhibitors have shown limited efficacy in treating RET fusion-positive NSCLC patients. However, selective RET inhibitors, such as selpercatinib and pralsetinib, have significantly improved the prognosis of those patients. The treatment strategy following resistance to selective RET inhibitors is a future research direction.

Objective To analyze the risk factors associated with the occurrence of rectal neuroendocrine tumors (RNETs) and construct a risk prediction model. Methods Clinical data of patients who underwent electronic colonoscopy were collected. The clinical information on patients with and without RNETs were compared, and potential risk factors for RNETs were identified. Binary logistic regression was performed to analyze the relevant risk factors and construct a risk prediction model. Results Among 164 patients, 66 were diagnosed with RNETs, and 98 who did not have such a condition were randomly selected. Univariate logistic regression analysis revealed that age, fatty liver, anxiety and depression, total cholesterol, triglyceride levels, and carcinoembryonic antigen (CEA) were significant factors influencing the occurrence of RNETs (P<0.05). Multivariate logistic regression analysis identified age (P=0.015), anxiety and depression (P=0.031), cholesterol level (P=0.009), fatty liver (P=0.001), and CEA (P<0.001) as independent risk factors for RNETs. The participants were randomly divided into training and test sets at a 7:3 ratio. The training set was used to construct a nomogram-based risk prediction model, and the testing set was used for internal validation. The area under the curve values for the training and testing sets were 0.843 and 0.772, respectively (P>0.05). These findings indicate a good discriminative performance. The calibration curves for the training and testing sets were in good agreement with the 45° standard line, which suggests that the predicted probabilities were consistent with the actual outcomes. Decision curve analysis showed that the model provided a high net benefit within a threshold range of 0.2 to 0.7 for clinical decision making. Conclusion Young age, fatty liver, high CEA levels, high cholesterol levels, and anxiety and depression are independent risk factors for RNETs. The nomogram model constructed based on these risk factors exhibits a strong capability to predict the occurrence of RNETs, and clinical intervention can be considered based on the predicted probability values.

Combined small cell lung cancer(C-SCLC)accounts for approximately 20%of all SCLC cases,while the propotion of C-SCLC mixed with squamous cell carcinoma component comprises less than 3%.At the pathological level,accurate diagnosis requires to distinguish it from other lung tumor types,and even rely on molecular testing.This article presents a case of a 67-year-old patient initially diagnosed with a peripheral lung tumor.The patient underwent comprehensive multidisciplinary management,including surgical resection,postoperative pathological differential diagnosis,chemotherapy,thoracic radiotherapy,brain metastasis,cranial radiotherapy,dynamic follow-up of imaging changes after cranial radiotherapy,and cranial surgery.Molecular residual disease(MRD)monitoring was integrated at critical time points during dynamic monitoring to inform personalized treatment decisions.The early MDT has brought the patient′s condition under control,and the overall survival of the patient exceeded 30 months.Through the introduction of the diagnosis and treatment process of this patient,we aim to offer novel perspectives on clinical decision-making for C-SCLC.

Objective:To evaluate the effect of preoperative neoadjuvant chemotherapy on rocuronium bromide-induced neuromuscular blockade in patients undergoing radical resection of gastrointestinal tumors.Methods:In this retrospective cohort study, the medical records from patients pathologically diagnosed with gastrointestinal tumors (stageⅡ or Ⅲ) and underwent elective radical tumour resection under general anaesthesia, aged 43-74 yr, with a body mass index of 18-25 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ at Shaanxi Provincial People′s Hospital from November 2021 to November 2022, were collected. The patients were divided into 2 groups based on whether preoperative neoadjuvant chemotherapy was performed: non-chemotherapy group and chemotherapy group. Non-chemotherapy group did not receive neoadjuvant chemotherapy before surgery and underwent direct surgery without receiving neoadjuvant chemotherapy. Chemotherapy group received 4 weeks of chemotherapy with FOLFOX (5-fluorouracil, leucovorin, oxaliplatin), XELOX (capecitabine + oxaliplatin) or SOX (oxaliplatin + tegio) the three regimens before surgery. The neuromuscular monitoring was initiated after induction of intravenous anaesthesia, and rocuronium bromide 0.6 mg/kg was intravenously injected when the train-of-four ratio stabilized at 90%-110%. Mechanical ventilation was performed after endotracheal intubation when the train-of-four count was 0. When T 1 began to recover, rocuronium 0.2 mg/kg was intravenously injected, and rocuronium was intermittently injected during operation to maintain muscle relaxation. The onset time, complete muscle relaxation time, recovery index, 90% recovery index, maintenance time and consumption of rocuronium were recorded. Results:A total of 40 patients were finally included, with 20 in each group. Compared with non-chemotherapy group, the onset time was significantly prolonged, the recovery index, 90% recovery index and consumption of rocuronium were increased, the time for complete muscle relaxation was shortened ( P<0.05), and no significant change was found in the maintenance time of muscle relaxation in chemotherapy group ( P>0.05). Conclusions:Preoperative neoadjuvant chemotherapy can prolong the onset and recovery time of rocuronium, shorten the time to complete muscle relaxation and increase the consumption in patients undergoing radical resection of gastrointestinal tumors.

Objective:To evaluate the effect of preoperative neoadjuvant chemotherapy on rocuronium bromide-induced neuromuscular blockade in patients undergoing radical resection of gastrointestinal tumors.Methods:In this retrospective cohort study, the medical records from patients pathologically diagnosed with gastrointestinal tumors (stageⅡ or Ⅲ) and underwent elective radical tumour resection under general anaesthesia, aged 43-74 yr, with a body mass index of 18-25 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ at Shaanxi Provincial People′s Hospital from November 2021 to November 2022, were collected. The patients were divided into 2 groups based on whether preoperative neoadjuvant chemotherapy was performed: non-chemotherapy group and chemotherapy group. Non-chemotherapy group did not receive neoadjuvant chemotherapy before surgery and underwent direct surgery without receiving neoadjuvant chemotherapy. Chemotherapy group received 4 weeks of chemotherapy with FOLFOX (5-fluorouracil, leucovorin, oxaliplatin), XELOX (capecitabine + oxaliplatin) or SOX (oxaliplatin + tegio) the three regimens before surgery. The neuromuscular monitoring was initiated after induction of intravenous anaesthesia, and rocuronium bromide 0.6 mg/kg was intravenously injected when the train-of-four ratio stabilized at 90%-110%. Mechanical ventilation was performed after endotracheal intubation when the train-of-four count was 0. When T 1 began to recover, rocuronium 0.2 mg/kg was intravenously injected, and rocuronium was intermittently injected during operation to maintain muscle relaxation. The onset time, complete muscle relaxation time, recovery index, 90% recovery index, maintenance time and consumption of rocuronium were recorded. Results:A total of 40 patients were finally included, with 20 in each group. Compared with non-chemotherapy group, the onset time was significantly prolonged, the recovery index, 90% recovery index and consumption of rocuronium were increased, the time for complete muscle relaxation was shortened ( P<0.05), and no significant change was found in the maintenance time of muscle relaxation in chemotherapy group ( P>0.05). Conclusions:Preoperative neoadjuvant chemotherapy can prolong the onset and recovery time of rocuronium, shorten the time to complete muscle relaxation and increase the consumption in patients undergoing radical resection of gastrointestinal tumors.

Combined small cell lung cancer(C-SCLC)accounts for approximately 20%of all SCLC cases,while the propotion of C-SCLC mixed with squamous cell carcinoma component comprises less than 3%.At the pathological level,accurate diagnosis requires to distinguish it from other lung tumor types,and even rely on molecular testing.This article presents a case of a 67-year-old patient initially diagnosed with a peripheral lung tumor.The patient underwent comprehensive multidisciplinary management,including surgical resection,postoperative pathological differential diagnosis,chemotherapy,thoracic radiotherapy,brain metastasis,cranial radiotherapy,dynamic follow-up of imaging changes after cranial radiotherapy,and cranial surgery.Molecular residual disease(MRD)monitoring was integrated at critical time points during dynamic monitoring to inform personalized treatment decisions.The early MDT has brought the patient′s condition under control,and the overall survival of the patient exceeded 30 months.Through the introduction of the diagnosis and treatment process of this patient,we aim to offer novel perspectives on clinical decision-making for C-SCLC.

Objective:Before the radiotherapy was performed, patients with pelvic tumors were analyzed for the consistency of bladder filling in the three steps of " Immobilization" , " CT Simulation" and " X-ray Simulation" .Methods:In 2014, 105 patients (68 cases of cervical cancer, 32 cases of rectal cancer, 3 cases of vaginal cancer and 2 cases of prostate cancer) with pelvic tumor radiotherapy were randomly assigned to monitor bladder urine volume to a target urine volume of 400 ml. First, patient were exhorted to empty the bladder, and the bladder volume meter BVI 9400 was used to measure the urine volume of the patient after emptying of the bladder. The patient immediately drank about 540 ml of water and suppressed urine, measurements were taken every 0.5 h. At the same time, when the patient complained of " urgency of urine" , bladder urine volume would be measured again and the time would also be recorded. Every other half an hour (emptying, 0.5 h after emptying, 1.0 h after emptying), when complaining of " urgency of urine" , when actually performing urine volume and time were described as: U 0 and t 0, U 0.5 and t 0.5, U 1.0 and t 1.0, U t and t, U T and T. Results:There was a statistically significant difference in gender and age, and women had stronger ability to urinate than men U 1.0( P=0.003), young people had stronger ability to urinate than middle-aged U 1.0( P=0.002). In the three-step comparison, there was no statistically difference between 1 hour after emptying urine volume U 1.0( P=0.177) and the actually performing urine volume U T ( P=0.052). And the final urine volume was concentrated at 298-526 ml. After the patient emptied the urine volume and complained of " urgency of urine" , the time slot was t=(75.2±49.9) min, with the urine volume of U t=(331.2±140.3) ml. And there was no statistically difference between U t and U T ( P=0.198) at X-ray Simulation. Conclusions:The patient emptied the bladder and immediately drank 540 ml of water. After 1 hour of suppressing urine, he complained of " urgency of urine" and achieved the target urine volume (400 ml). At this time, the bladder urine volume U 1.0 was consistency in the immobilization, CT Simulation, and X-ray Simulation.

Objective:To investigate the diagnosis and treatment of hepatic artery thrombosis (HAT) after adult orthotopic liver transplantation.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 411 patients who underwent adult orthotopic liver transplantation in the First Affiliated Hospital of Xi ′an Jiaotong University from December 2011 to July 2018 were collected. There were 328 males and 83 females, aged from 21 to 66 years, with a median age of 46 years. Observation indicators: (1) incidence of HAT and its clinical characteristics; (2) diagnosis of HAT; (3) treatment of HAT; (4) follow-up. Follow-up using outpatient service, telephone interview or WeChat group communication was conducted to detect the incidence of biliary stricture and survival of patients up to August 2018. Measurement data with normal distribution were represented as Mean± SD, measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages. Survival rate was estimated using the Kaplan-Meier method. Results:(1) Incidence of HAT and its clinical characteristics: 11 of 411 patients had HAT after orthotopic liver transplantation with the incidence of 2.68%(11/411), including 10 males and 1 female, aged 44 years(range, 22-63 years). The time to occurrence of postoperative HAT was 4 days(range, 1-15 days). The etiologies of 11 patients included 6 cases of hepatitis B virus-related cirrhosis, 1 case of hapatitis related cirrhosis, 1 case of hepato-cellular carcinoma, 1 case of liver cirrhosis, 1 case of alcoholic hepatitis related cirrhosis, 1 case of wilson disease. All the 11 patients were ABO compatible. The cold ischemic time and warm ischemic time of donor liver were (316±89)minutes and (13±4)minutes, respectively. Type Ⅰ arterial anasto-mosis was conducted in 11 patients. The clinical manifestations included asymptomatic type in 10 patients and sepsis type in 1 patient. (2) Diagnosis of HAT: all the 11 patients were confirmed with HAT by endovascular angiography, including 7 cases showed no arterial flow under Color Doppler ultrasound, and contrast-enhanced ultrasound indicated HAT. Two patients showed increased hepatic artery resistance index under Color Doppler ultrasound, and contrast-enhanced ultrasound indicated 1 case of HAT and 1 case of anastomotic stenosis. One patient showed slow velocity of hepatic artery blood flow and low resistance index under color Doppler ultrasound, and contrast-enhanced ultrasound indicated HAT. One patient showed slight blood flow signals under Color Doppler ultrasound, and contrast-enhanced ultrasound indicated HAT. (3) Treatment of HAT: 11 patients received endovascular therapy. Six patients had HAT completely disappeared after thrombolytic therapy, 5 patients with residual thrombosis continued thrombolytic therapy with microcatheter urokinase. Six patients with complications were improved after symptomatic treatment. HAT completely disappeared after (6.7±2.6)days of treatment and the clinical success rate was 11/11. (4) Follow-up: 11 patients were followed up for 19-1 722 days, with a median follow-up time of 46 days. During the follow-up, 4 patients had biliary stricture and underwent stent implantation. Nine patients survived with 1-, 3-, 5-year overall survival rates of 75%, 75%, 75%, and 2 patients died.Conclusions:The incidence of HAT after adult orthotopic liver transplantation is low and clinical manifestations are atypical. Contrast enhanced ultrasound can improve diagnosis of suspected thrombosis. Endovascular therapy is safe and effective, which can significantly improve the blood flow of hepatic artery.

Freshwater snail is an important biological group in aquatic ecosystem and an intermediate host of many parasites. Intestinal flora plays an important role in animal energy metabolism and resistance to pathogens. We analyzed the intestinal microbiota diversity of Radix auricularia (RA) and Planorbella trivolvis (PL) by 16S rRNA high-throughput sequencing. At the phylum level, RA had 23 phyla, including Proteobacteria (33.63%), Cyanobacteria (15.33%), Chloroflexi (13.95%), and Actinomycetes (12.99%). PL had 13 phyla, including Proteobacteria (54.88%), Bacteroidetes (28.49%), and Actinomycetes (7.65%). At the genus level, there were 445 genera in RA, including Pleurocapsa, Thiodictyon, Leptotrichia, and Nocardioides. There were 238 genera in PL, including Cloacibacterium, OM60NOR5_clade, Pseudomonas, and Rhodobacter. Ninety-three genera were the common core flora of the two snail species (all the samples were present), and 27 genera had an abundance greater than 0.5%. The structure of intestinal microbiota was significantly different between the two groups (P=0.027). We performed the functional prediction of intestinal microbiota using Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt), and the results show that the KEGG functional composition of the intestinal flora of the two snails was similar, and the abundance of the amino acid metabolism, carbohydrate metabolism and membrane transport were large. In summary, the intestinal microbiota of the two snails was high in diversity and significantly different, but there were a large number of common core flora.
Animals ; Auricularia ; Ecosystem ; Fresh Water ; Gastrointestinal Microbiome/genetics* ; High-Throughput Nucleotide Sequencing ; Phylogeny ; RNA, Ribosomal, 16S/genetics* ; Snails

Objective:To evaluate the clinical characteristics and prognosis of gallbladder cancer (GBC) patients in China.Methods:This retrospective multicenter cohort study enrolled 3 528 consecutive GBC patients diagnosed between January 2010 to December 2017 in 15 hospitals from 10 provinces. There were 1 345 (38.12%) males and 2 183 (61.88%) females.The age of diagnosis was (63.7±10.8) years old (range: 26 to 99 years old) .There were 213 patients (6.04%) in stage 0 to Ⅰ, whereas 1 059 (30.02%) in stage Ⅱ to Ⅲ, 1 874 (53.12%) in stage Ⅳ, and 382 (10.83%) unavailable. Surgery was performed on 2 255 patients (63.92%) . Three hundred and thirty-six patients received chemotherapy or radiotherapy (9.52%; of which 172 were palliative); 1 101 (31.21%) received only supportive treatment.The patient source, treatment and surgery, pathology, concomitant gallstone, and prognosis were analyzed.Results:Among the 3 528 GBC patients, 959 (27.18%) were from East China, 603 (17.09%) from East-North China, 1 533 (43.45%) from Central China, and 433(12.27%) from West China. Among the 1 578 resectable tumor, 665 (42.14%) underwent radical surgery, 913 (57.86%) underwent surgery that failed to follow the guidelines.Eight hundred and ninety-one (56.46%) patients were diagnosed before surgery, 254 (16.10%) during surgery, and 381 (24.14%) after surgery (time point of diagnosis couldn′t be determined in 52 patients) .Among the 1 578 patients with resectable tumor, 759 (48.10%) had concomitant gallstone.Among the 665 patients underwent radical surgery, 69 (10.4%) showed positive resection margin, 510 (76.7%) showed negative resection margin, and 86 (12.9%) unreported margin status.The 5-year overall survival rate (5yOS) for the 3 528-patient cohort was 23.0%.The 5yOS for patients with resectable tumor was 39.6%, for patients with stage ⅣB tumor without surgery was 5.4%, and for patients with stage ⅣB tumor underwent palliative surgery was 4.7%.Conclusions:More than half GBC patients in China are diagnosed in stage Ⅳ.Curative intent surgery is valuable in improving prognosis of resectable GBC.The treatment of GBC needs further standardization.Effective comprehensive treatment for GBC is in urgent need.